National Care Service (Scotland) Bill (Stage 2) - Your views on draft amendments

The proposed amendments in section 1 aim to provide clarity in relation to the general principles of the National Care Service. Areas of amendment and focus include:

• Recognising people’s individual needs
• Support for people to live independently
• Recognition on increasing and increasing complex need
• Ensuring that services are experience by people using those services and their carers as integrated
• Ensuring that service improvement activity takes into account the whole life experience of people
• Ensuring that services provided by the NCS protect and improve the safety of people to whom the services are provided
• Recognition of the diverse communication needs of people
• Ensuring that the NCS workforce are recognised for the work that they do.

Section 1 states that the National Care Service Principles will be reviewed within 5 years of coming into force which is generally welcomed.

A key amendment to Section 1 of the Bill is the development of the National Care Service Strategy, it details the approach to the development and review of the strategy. This provides a clear statement of the aims of the service, the challenges that it seeks to address and the actions that will be taken. This detail alongside the requirement to conduct a public consultation to inform the development of the national strategy is generally welcomed by West Lothian Council.

The Council recognises the importance of a national strategy that supports and enables such whole system working – one that is fully costed and appropriately funded; is realistic about the implications of demographic change for both service demand and workforce availability; and where Scottish Government engages with the public on why and how models of care and service delivery have to be updated, redesigned and reformed.
However, it is important to note that the strategy must recognise the need to provide locally tailored and locally funded solutions and should therefore be designed in a manner that has regard to the specific needs of different areas.

It should also be noted that Audit Scotland’s recent report “Integration Joint Boards: Finance and Performance 2024” highlighted the complex and unprecedented challenges currently faced by health and social care services across Scotland. There is increasing demand for service, ongoing workforce challenges coupled with increasing financial pressure across the public sector.

The proposals do not directly address the existing challenges relating to how services are funded.

The council also proposes that local authorities and health boards should be added to the list at Section 1A(2)(b) (those whom the Scottish Ministers must elicit the views of in reviewing the NCS principles).

Chapter 1B of Part 1 of the Bill and Schedule 2C are new additions to the Bill and outline:

• the approach that will be taken to the development of the National Care Service;
• general purpose of the National Care Service Board;
• the duty to comply with Ministerial directions;
• the duty to have regard to Ministerial guidance;
• financing of the National Care Service Board;
• the requirement to develop a National Care Service Corporate Plan;
• responsibility for monitoring and improvement;
• procuring of goods and services.


While the Council recognises that there is a role for a national approach and consistency in relation to national improvement, standards and oversight it is not clear that this is best progressed through the development of a National Care Service Board. Further clarification is required in relation to:

• the provisions for the National Care Service Board to remove members of a National Care Service Local Board, including locally elected members. West Lothian Council would strongly oppose any proposals in relation to this due to the implications that this would have for local accountability.
• The costs of creating and operating a new national Board with its associated infrastructure, particularly given the financial challenges facing local and front-line health and social care services.

The development of the National Care Service will also provide an additional layer of governance and reporting for health and social care services. The governance and reporting arrangements within which health and social care services currently operate is already complex and therefore further detail will be required on the reporting and governance requirements that will result from the development of the National Care Service Board.

While the Scottish Government’s movement through the course of the Stage 1 Bill process to a shared accountability agreement is acknowledged, the Council’s position continues to be that the proposed legislative and structural change is not necessary and distracts from the significant and urgent investment that is required in social work and social care.

Amendments in Chapter 1A of Part 1 of the Bill and new schedules 2A and 2B relate to the creation of local boards and the removal of other integration models.

The amendments within this Chapter and associated schedules generally relate to modifications to the Public Bodies (Joint Working) (Scotland) Act 2014. Key areas include the renaming of the title of Part 1 of the Act to “National Care Service Local Board” and a general substituting of National Care Service Local Board for Integration Joint Board.

The proposal to establish Local Boards, by reforming current integration authorities, which would be accountable to the National Board, which would have implications for local democratic accountability. Amendments to the Bill should include details of the composition of local boards, and these should be designed to ensure that local services are still democratically represented.

The council has no particular concerns in relation to the proposal to remove other integration models.

Sections 12K and 12L are new sections within the Bill which outline the monitoring and improvement functions of the National Care Service. These sections make reference to ensuring that any decisions in relation to improvement activity must be consistent with the strategic plan of the National Care Service local board.

West Lothian Council is generally supportive of a framework developed to help the National Board to take oversight of National Care Service Local Boards as long as it is proportionate and effective in delivering a basis for meaningful discussion and decision making, supporting change.

For the framework to be effective, it needs to be integrated across health and social care services, in contrast to current outcomes and indicators which are health service focused. It is important to stress that working collaboratively and supportively with the local authorities and health boards is essential to the delivery of any improvement activity. Clear criteria will also be needed to determine when improvement is needed and a comprehensive and integrated set of performance indicators covering the entirety of the services delivered by local boards and balance the different priorities/partners of the system is essential.

Local health and social care planning and delivery is already subject to a very high level of reporting and scrutiny in a range of formal governance. As such, there is a potential risk that a new NCS Board that would bring further bureaucracy. The proposals would be strengthened by a greater emphasis on and commitment to be simplifying, streamlining and coordinating monitoring and improvement support for local services.

There is a case for improved coordination and clarity of national monitoring and improvement activity across health and social care, across Scottish Government and the range of national regulatory, scrutiny and improvement bodies.

Section 12M enables the National Care Service Board to procure good and services.

West Lothian Council supports the proposal that Local authorities will continue to have the responsibility for procuring social care services. The knowledge of local need, priorities and resources that local authorities have, is crucial. In relation to the NCS Board being able to arrange specialist or complex services on a national basis, arrangements are already in place via Scotland Excel to do this.

The Council also welcomes the development of guidance and tools to support ethical commissioning including fair work and a just transition.

The provisions would be strengthened by being clear on the technical differences in the terms strategic commissioning and procurement.

It should also be noted that effective commissioning depends on funding levels which are adequate to support the spectrum of prevention, early intervention, mitigation and crisis management; and to ensure a resilient and adequate workforce.

West Lothian Council recognises the importance of a constructive and positive working relationship between local authority Chief Social Work Officers and the Scottish Government Chief Social Work Adviser as already exists.

Further consideration and detail is required on how the National Chief Social Work Officer would interact with Chief Social Work Officers of local authorities who are existing statutory officers with a range of legislative duties and functions.

Further clarity is required in relation to the role of the NSWA to avoid duplication of roles with existing care regulators such as the SSSC and the Care Inspectorate.

Further detail should be developed in partnership and full collaboration with Social Work Scotland, COSLA and OCSWA. These should include resourcing, level of autonomy, independence and flexibility to respond to local need.

There remains a general concern about the further creation of an additional non-governmental public body to add to the already complex national regulatory, scrutiny and improvement landscape.

The proposed amendments to the Public Bodies (Joint Working) (Scotland) Act 2014 include the substitution of terminology in relation to Integration Joint Board for National Care Service Local Boards and reflections of the National Care Service principles and strategy, the council has no concern in relation to these amendments.

It is the Council’s view that many of the outcomes sought could be achieved by reviewing and amending the 2014 Act, as opposed to the creation of a new National Care Service.

The areas of further work are material considerations under this Bill which could have significant impacts on local authorities, health boards, service users and other relevant parties. As the further work is undertaken, we would suggest that clear communication and information sharing from the Scottish Government to those partners is key. We note that this has been lacking up until now despite the efforts of COSLA to engage with the Scottish Government on behalf of local authorities.

COSLA has undertaken extensive discussions and negotiations with the Scottish Government concerning a number of ongoing challenges and risks in respect of the NCS. There is concern that these negotiations have not resulted in positive outcomes, with a number of matters remaining unresolved, including fundamental disagreement on the areas detailed above (with the exception of Anne’s Law).

Direct funding

Funding for IJBs at present is allocated through local authorities and the NHS. As such, there are concerns that these proposals carry a potential for current funding arrangements to be undermined, thereby impacting on the level of control and influence that the local bodies can exert on service delivery and design. Direct funding risks bypassing local government and NHS Boards, thereby undermining their role in planning and delivering local services. It is essential that the scope and criteria for any direct funding arrangements are developed and agreed by all parties, in line with the shared accountability agreement.

Inclusion of Children's Services and Justice Social Work

The Council’s position on children’s and justice services has been to strongly advocate for these services remaining within the Council’s remit, primarily because their transfer risks creating disconnects with early years provision, education and housing and homelessness services, which would continue to be delivered by local authorities.

As has been articulated by COSLA, it continues to be the Council’s view that the inclusion of children’s social work services should be a decision that is taken at a local level.

The justice community has already, and relatively recently, undergone a period of reform - from the establishment of Community Justice Authorities to the establishment of Criminal Justice Scotland. In addition, the evidence is clear that better access to welfare, housing, and employability assistance, as well as health care, have an important role in reducing or even prevent offending. Similarly, the shift away from short prison sentences needs effective, evidence based community interventions.

It continues to be the council’s view that the inclusion of social work justice services should be a decision that is taken at a local level.

Anne's Law

In relation to Anne’s Law West Lothian Council is generally supportive and would consider the further extension of these provisions to include people within hospital settings.

West Lothian Council generally supports the development of the draft charter and welcomes the co-design approach that has been taken.

The current draft of the Charter appears to be an easy to read/use document for service users and all other relevant parties, which clearly sets out their rights; and the duties/roles of those who provide social work, social care, and support.

West Lothian Council recognises that reform is needed in the social care system which has been under severe pressure for a number of years and acknowledges the ambition in the NCS Bill to improve care services in Scotland and support that principle.

However, we do not see the clear, evidence-base argument that major structural change will result in that improvement.
Long term underinvestment in social care has contributed to the longstanding challenges faced by the system. The Council’s view, as stated in the response to the initial National Care Service consultation, is that additional funding could support significant improvements within current arrangements.

Structural change imposed without additional resources is unlikely to result in any change in the level and quality of services offered to people across Scotland.

Investment in the current system of care, with locally based design and additional powers would deliver the improvements required, while retaining local accountability and locally based solutions.

The council remains seriously concerned about the affordability of commitments, the cost of the new arrangements, the long term under resourcing of social care under current arrangements and the impact on local democracy and accountability.

It continues to be the Council’s position that, legislative or structural change is not necessary and is unlikely to address the significant and urgent investment required in social work and social care.